System Leadership and Medicines Optimisation in Surrey Heartlands: Our Journey East Sussex, West Sussex and Surrey LPCs Linda Honey Interim Director of Pharmacy and Medicines Optimisation 10 th July 2019
The recent system
The recent system • Fragmented and complex health system • Multiplicity of providers • Different employers and different employing arrangements • Multiple information systems • Results in silo thinking and missed opportunities
But people want a:
And we have these priorities • Reducing variation • Reducing polypharmacy • Antimicrobial stewardship • Improving transfer of care • Improving access to our services • Reducing medicines waste • Addressing workforce challenges • Preventing patient harm (WHO global challenge) • Improving pharmacy input into the prevention agenda
And we need to deliver the LTP The NHS Long Term Plan is about integrating services around the patient more effectively, and making inroads into the major ‘killer’ diseases and causes of ill health. Its three main ambitions: 1. Making sure 2. Delivering world class 3. Supporting everyone gets the care for major health people to age well best start in life problems Ambitions underpinned by action to overcome specific challenges: Personalised care, Prevention and health inequalities, Workforce, Data and digital technology, Delivering better value
So, what if we….?
And what if we….?
Primary And went Care from here Acute Care CCG Mental Community Health Pharmacy Ambulance Community Trust Trust
Primary care To here Acute trust CCG Surrey Heartlands Patient Mental Community Pharmacy Health Pharmacy Workforce Community Ambulance Trust Providers
What if we started to see the pharmacy workforce as one – what would that look like from a system leadership perspective?
Started with a belief that we are better together • We began by sharing our stories, our vision, our pressures • Began to collaborate on workforce issues, training, recruitment and development, opportunities for sharing resources • Started to build a coalition of the willing • Developed a model for system leadership • Began to engage our own workforce in this journey (OD)
From sharing strategies to owning shared objectives • Transfer of care around medicines (PharmOutcomes) • Medication safety • Workforce • Tackling antimicrobial resistance • Medicines Optimisation in Care Homes • Digital • Medicines Value Programme • Acute Pharmacy Transformation
Integrating Pharmacy and Medicines Optimisation (IPMO) into STPs/ICS: aims ‘ to develop a framework which will set out how to systematically tackle the medicines optimisation priorities for the local population in an STP/ICS footprint and use the expertise of pharmacy professionals in the strategic transformation of systems in order to deliver the best patient outcomes from medicines and value to the taxpayer ’
IPMO into STPs/ICS: objectives • To develop and test a core set of principles that set out how NHS pharmacy and medicines optimisation can be best integrated into STP/ICSs • To define the functions of leadership for NHS pharmacy and medicines that should be undertaken at system level and describe how these would be delivered • To ensure visible professional expertise and leadership in NHS pharmacy and medicines at system level • To identify and accelerate strategies to achieve medicines optimisation at scale to improve patient outcomes and value for money across primary and secondary care • To explore the approach to developing an integrated, flexible, clinical pharmacy workforce that can deliver high quality and sustainable medicines optimisation at scale, across a local system • To inform the national priorities on how best to support systems in unlocking the barriers that will increase opportunities for effective medicines optimisation in STP/ICSs
From medicines optimisation group to established and recognised transformation work stream • Medicines Optimisation Programme Board • Medicines Optimisation Steering Group • Executive Sponsors • Strategy Lead • Programme Manager
SH Draft Long Term Leadership Structure Chief Pharmaceutical Officer DRAFT MODEL NHSE/I Regional Pharmacist LPC CEO SH SRO SH Clinical Director of Pharmacy 1WTE Delivery Board Med. Opt. Programme Board Transformation Board • • • NWS ICP G&W ICP SD ICP • ES ICP • • • Chief Pharmacist 1 Chief Pharmacist 1 Chief Pharmacist 1 • Chief Pharmacist 1 WTE WTE WTE WTE • • • LPC Rep LPC Rep LPC Rep • LPC Rep Surrey & Borders Chief Pharmacist (wider role than Surrey Heartlands) Surrey Heartlands ICS Pharmacist (lead for pharmacy services provided at scale across SH ICS) 2WTE
• Each person can access joined up, proactive and personalised care, based on ‘what Individual matters’ to them and their individual strengths, needs and preferences • Practices continue to provide core services Neighbourhood • Network Contract DES provides practices opportunity to work collaboratively with c.30k~50k other practices health, social care and voluntary partners to deliver services • Practices and other health, social care and voluntary partners collaborate as primary PCN care networks, providing additional services that can’t be delivered on a smaller scale • Primary care interacts with hospitals , mental health trusts, local authorities and Place community providers to plan and deliver integrated care c.250-500k ICP • Primary care participates as an equal partner in decision making on strategy and System resource allocation c.1+m • Action is taken to ensure collaboration across hospitals, community services, social ICS care and other partners, helping to join up and improve care • Data is used to deploy resources where they can have the maximum impact Supporting the development of primary care networks 18 |
Vision for the integrated clinical pharmacy team • All pharmacists and pharmacy technicians supporting patients are IPMO next steps: part of the multi-professional team in a PCN • Publish 7 case studies for • Clinical pharmacists are a central part of the PCN team Integrating Pharmacy and • Community pharmacy teams deliver consistent, high-quality Medicines Optimisation minor illness care and support the public to live healthier lives • across an ICS pilots Community pharmacists have capacity to deliver more • Further develop clinical care • Hospital and mental health pharmacists continue to be part of governance framework for specialist teams and extend their practice into primary care, IPMO and evaluate including providing consultant pharmacist support • Pilot project to continue for • CCG pharmacy teams leading on population health two years and roll-out to • Consistent delivery of these goals will require clinical and other STP/ICSs professional leadership across the health and care system, by • Regional chief pharmacists Regional Chief Pharmacists and proposed Clinical Directors of continue to lead Pharmacy and Medicines in each ICS
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